Provider Demographics
NPI:1821063165
Name:COLLINS, JOHN PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 SIGNAL BELL LN
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-2606
Mailing Address - Country:US
Mailing Address - Phone:443-535-9900
Mailing Address - Fax:443-535-9901
Practice Address - Street 1:5005 SIGNAL BELL LN
Practice Address - Street 2:SUITE 208
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-2606
Practice Address - Country:US
Practice Address - Phone:443-535-9900
Practice Address - Fax:443-535-9901
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0044649208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD043911800Medicaid
MD632L186DMedicare ID - Type Unspecified
MDF62491Medicare UPIN